S.M.A.R.T. Treatment Planning Utilising the ASI

1. S.M.A.R.T. Treatment Planning Utilising the ASI Treatnet Training Volume A, Module 3 - Updated: 12 January, 2007

2. Module 3 training goals • Increase familiarity with treatment planning process • Increase understanding of guidelines and legal considerations in documenting client status • Increase skills in using the ASI in developing treatment plans and documenting activities

3. Workshop 1: Understanding Treatment Planning and the ASI

4. Pre-assessment Please respond to the pre-assessment questions in your workbook. (Your responses are strictly confidential.) 10 minutes

5. Icebreaker How do you define treatment planning?

6. Icebreaker: The Good and the Bad

7. The Good and the Bad

8. Workshop 1: Training objectives (1) At the end of this workshop, you will be able to: • Use ASI information to develop individualised treatment plans • Identify characteristics of a programme-driven and an individualised treatment plan • Understand how individualised treatment plans help to keep people in treatment and lead to better outcomes

9. Workshop 1: Training objectives (2) At the end of this workshop, you will be able to: • Use Master Problem List (provided) to formulate treatment plans and develop: • Problem statements • Goals based on problem statements • Objectives based on goals • Interventions based on objectives • Practise writing documentation notes reflecting how treatment plan is progressing (or not progressing)

10. What is not included in training • Administering and scoring the ASI • Administering any other standardised screening/assessment tool • Training on clinical interviewing

11. The goal of this training is… To bring together the assessment and treatment planning processes

12. “Same plan, different names” Treatment plans are often. . . “Meaningless & time consuming” “Ignored”

13. The What, Who, When, and How of Treatment Planning

14. What is a treatment plan? • A written document that: • Identifies the client’s most important goals for treatment • Describes measurable, time-sensitive steps towards achieving those goals • Reflects a verbal agreement between the counsellor and client Source: Center for Substance Abuse Treatment, 2002

15. Who develops the treatment plan? • Client works with treatment providers to identify and agree on treatment goals and identify strategies for achieving them.

16. When is the treatment plan developed? • At the time of admission • And continually updated and revised throughout treatment

17. How does assessment guide treatment planning? • The Addiction Severity Index (ASI), for example, identifies client needs or problems by using a semi-structured interview format • The ASI guides delivery of services that the client needs

18. How does assessment guide treatment planning? • Treatment goals address those problems identified by the assessment • Then, the treatment plan guides the delivery of services needed

19. What is the ASI? • A reliable and valid instrument, widely used both nationally and internationally • Conducted in a semi-structured interview format • Can be effectively integrated into clinical care Sources: Cacciola et al., 1999; Carise et al., 2004; Kosten et al., 1987; McLellan et al., 1980; 1985; 1992

20. What is the ASI? • Identifies 7 potential problem areas: • Medical status • Employment and support • Drug use • Alcohol use • Legal status • Family/social status • Psychiatric status

21. The ASI is NOT… • A personality test • A medical test • A projective test such as the Rorschach Inkblot Test • A tool that gives you a diagnosis

22. Why use the ASI? • Clinical applications • Evaluation uses

23. Recent developments • Efforts focused on making the ASI more useful for clinical work • (Example: Using ASI for treatment planning) • The Drug Evaluation Network System (DENS) Software uses ASI information to create a clinical narrative.

24. ASI is now more clinically useful! New and Improved DENS Software (2005) Uses ASI information to define possible problem lists and prompt and guide clinician in developing a treatment plan.

25. Clinical application Why use the ASI? • Uses a semi-structured interview to gather information a clinician generally collects during assessment • Shown to be an accurate or valid measure of the nature and severity of client problems Source: Kosten et al., 1987; McLellan et al., 1980; 1985; 1992

26. Clinical application Why use the ASI? • Prompts clinician to focus session on important problems, goals, and objectives • Basis for reviews of progress during treatment and documentation • Basis for discharge plan

27. Clinical application Why use the ASI? • NIDA Principle 3: • To be effective, treatment must address the individual’s drug use and any associated medical, psychological, social, vocational, and legal problems. • The ASI assesses all these dimensions.

28. Clinical application

29. Clinical application Clinical use of ASI improves rapport “. . . If patients’ problems are accurately assessed, they may feel ‘heard’ by their counsellor, potentially leading to the development of rapport and even a stronger helping alliance.” Sources: Barber et al., 1999, 2001; Luborsky et al., 1986, 1996

30. Clinical application Using ASI to match services to client problems improves retention. “. . . Patients whose problems are identified at admission, and then receive services that are matched to those problems, stay in treatment longer.” Sources: Carise et al., 2004; Hser et al., 1999; Kosten et al., 1987; McLellan et al., 1999

31. Evaluation uses • For Programme Directors • Identifies types of client problems not addressed through the programme’s treatment services • Quantifies client problems • Identifies trends over time

32. Evaluation uses • For Programme Directors • Assists with level-of-care choices • Provides measure of programme success • Documents unmet client service needs • Includes data needed for reports to various stakeholders

33. Evaluation uses • For Programme Directors • Positions programmes for increased funding though participation in clinical trials and other research opportunities

34. Evaluation uses • For Clinical Supervisors • ASI data can be used to: • Identify counsellor strengths and training needs • Match clients to counsellor strengths • Identify trends in client problems

35. Workshop 2: Treatment plans Programme-Driven versus Individualised

36. Sociological Biopsychosocial Model Biological Psychological

37. Biopsychosocial Model example ... Does the client have a car? Can they access public transportation? How available are drugs or alcohol in the home? Sociological How close do they live to the treatment centre?

38. ASI problem domains and the biopsychosocial model Biological (e.g., medical status) Psychological (e.g., psychiatric status) Sociological (e.g., family & social status)

39. Field of substance abuse treatment: Early work Field of Substance Abuse Treatment: Early Work Programme-Driven Plans “One size fits all”

40. Programme-driven plans • Client needs are not important as the client is “fit” into the standard treatment programme regimen • Plan often includes only standard programme components (e.g., group, individual sessions) • Little difference among • clients’ treatment plans

41. Programme-driven plans • Client will . . . • “Attend 3 Alcoholic Anonymous meetings a week” • “Complete Steps 1, 2, & 3” • “Attend group sessions 3 times/week” • “Meet with counsellor 1 time/week” • “Complete 28-day programme” “Still don’t fit right”

42. Programme-driven plans • Often include only those services immediately available in agency • Often do not include referrals to community services (e.g., parenting classes) “ONLY wooden shoes?”

43. - Custom style & fit - Treatment planning: A paradigm shift Individualized Treatment Plans - Many colors/styles available -

44. Individualised plan “Sized” to match client’s problems and needs

45. To individualise a plan, what information is needed? • What does a counsellor need to discuss with a client before developing a treatment plan? • Where do you get the information, guidelines, tools, etc.?

46. To individualise a plan, what information is needed? • Possible sources of information might include: • Probation reports • Screening results • Assessment scales • Collateral interviews

47. Case A assessment information: Jan • 27-year-old, single Caucasian female • 3 children under age 7 • No childcare available • Social companions use drugs/alcohol • Unemployed • Low education level • 2 arrests for possession of meth & cannabis plus 1 probation violation

48. Case B assessment information: Dan • 36-year-old, married African-American male • 2 children • 2 arrests and 1 conviction for DUI (driving under the influence of alcohol) • Blood alcohol content at arrest: .25 • Employed • High severity family problems

49. The “Old Method”: (Programme-Driven) Problem Statement “Alcohol dependence” • Not individualised • Not a complete sentence • Doesn’t provide enough information • A diagnosis is not a complete problem statement

50. The “Old Method”: (Programme-Driven) Goal Statement “Will refrain from all substance use now and in the future” • Not specific for Jan or Dan • Not helpful for treatment planning • Cannot be accomplished by programme discharge